Abstract: Employee #1, a maintenance mechanic in a large tortilla bakery/factory, had been asked to check on a problem on corn line #12. Tortillas were stuck inside the conveyor that ran between the main line and the bagger, and had to be removed. On arriving at the machine, Employee #1 neither locked it out nor turned off the conveyor, but instead removed the bagger lid and cleaned out the bottom of its tray. When he finished this, he asked the packer who regularly worked at that location to turn the power back on. He then had the packer shut it down again, and he worked for awhile longer beneath the conveyor line. While he was under the conveyor, he asked the packer to start the machine back up. This time, the packer said he was busy and couldn't assist him, so Employee #1 asked a nearby leadman if he could do it. The leadman obliged, but the power would not go back on because the machine's interlocked lid was open. The leadman closed the lid, asked Employee #1 if he still wanted the power back on. Employee #1 responded in the affirmative, and the leadman started the conveyor. Employee #1's left hand was promptly caught between the conveyor's sprocket and chain drive, amputating portions of his middle and ring fingers.